Blood & blood products, it’s

complications & management

(19040, 19041, 19042)
 Blood
• It is transporting fluid.
• It carries vital substances to all parts of the body
• Average human has 5L of blood ( 8% of total body weight)
Properties of blood
• Oxygen rich blood is bright crimson red
• Oxygen poor blood is purple red
• red colour comes frm Several million red cells present in it.
•PH must remain btw 7.35 -7.45
•Temp is 38°c
• Blood Is 5 times more viscous than water
• Blood is specialized type of connective tissue In which living blood cells
(formed elements) are suspended In a non living Fluid matrix called
Plasma
• Cellular part – formed elements
• Non cellular part – Plasma
Functions of blood
• Tranportation- blood transports Oxygen & nutrients to cells,CO2 &
waste away frm the cells,hormones to target tissues
• Regulation- helps maintain stable body temp , ph ,water & electrolyte
levels.
• Protection-Wbc; s protects against disease by phagocytosis.
• Blood products
• Components of blood which are collected frm a donor for use in
blood transfusion
• Obstetric practice is fret with Massive haemorrhage which requires
blood transfusion
•Blood from a donor is collected as whole blood in a suitable donor bag
that contains an anticoagulant
•1 unit of blood consists of 450 ml of blood in 63 ml of anticoagulant
( commonly acid citrate dextrose) in the donor bag.
•Blood in blood Bags is stored at 2- 6° c & can be used for up to 35 days.
•Infections may be transmitted by transfusion. Hence prior to
transfusion of collected blood,it is tested for.
Hepatitis B (for HBsAg by ELISA),hepatitis C(for antiHCV by ELISA)
HIV( for anti-HIV1,2 by ELISA),syphilis( for treponema Ag by
VDRL),malaria ( for malarial ag)
• Compatibility testing
• Done in 3 steps
1) ABO Rh Typing
2) Cross matching
3) Antibody screening
• ABO Rh typing
• Determination of Patients correct blood type Is imp & done by testing rbc for A &
B antigens And serum for A & B antibodies . Rh typing Is also carried out.
• Cross matching
Trial transfusion In which donor red cells are mixed With recipient serum to detect
Potential for Serious transfusion reaction
It takes about 45 – 60 min for Cross matching
In a small test tube, place a drop of recipient’s serum
Add washed donor red cells suspended In 5% saline
Mix the two & incubate at 37° for 30 min.
Centrifuge it at 3000 rpm for 1 min.
After dislodging the cell palette gently frm the centrifuge tube,examine it for
presence or absence of agglutination & hemolytic,first grossly & then under low
power of microscope
Interpretation-
▪︎if there is no agglutination or haemolysis, the donor- recipient blood
grps are matched
▪︎If there is agglutination, then blood grps are mismatched
Antibody screening
This is also carried out In 3 phases & llr to length of Cross match .The
screen for unexpected antibodies is also carried out on donor serum.
This screen is performed to prevent reactions btw transfused Donor
units.
 Storage of blood
• Blood Is stored In citrate- Phosphate- Dextrose- Adenine
anticoagulant preservative at 1- 6 °c. Citrate acts as anticoagulant,
Phosphate acts as buffer & Dextrose is energy source for rbc.
Indications for whole blood transfusion
• 1) acute blood loss
• Acute symptomatic anaemia
• Hypovolaemic & septic shock
• Traumatic haemorrhage eg. In major road accidents
• Surgical haemorrhage eg. In major surgery
• 2) chronic blood loss
• Chronic anaemia eg. In chronic renal failure,bleeding disorders
• Congestive heart failure
Blood Component Therapy
1. Packed Red Blood cells
2. Platelet concentrates
3. Fresh Frozen Plasma
4. Cryoprecipitate
5. Prothrombin complex
6. Single Donor Plasma
Packed Red Blood cells
● It is a general thumb rule now that blood losses < 2,500 mL/ 70 kg should be given packed cells, while
blood loss > 2,500 mL/70 kg should be given whole blood.
● Whole blood should be only used in cases of severe hemorrhage where intravascular volume is to be
replaced,Otherwise, packed cells are to be used

Indication
● Hemolytic anemia
● Hypoplastic anemia
● Severe anemia of any cause to reduce the chances of circulatory overload
● Hypovolemia due to hemorrhage
● Blood loss during surgery
Platelet concentrates
Platelet concentrates are prepared by differential centrifugation. If platelets are stored at room
temperature, they can be used till 5 days after collection with constant and gentle agitation.

Indications
● Thrombocytopenia, when platelet count is < 20,000 /mm³
● Platelet transfusion should be ABO compatible. One platelet transfusion usually increases platelet count
by 5,000-10,000/μL.
● Disseminated intravascular coagulation
● Organ transplant patients ( eg.Liver transplant)
● However, ABO incompatible platelets can be transfused as platelet have shorter life span
● Rh incompatibility should always be considered in obstetric population
● Administer anti-D immunoglobulin, if Rh-positive platelet are administered to Rh-negative individual
Fresh Frozen Plasma
Fresh frozen plasma (FFP) is prepared by freezing the plasma and contains plasma proteins and all
coagulation factors that include albumin, protein C and S, antithrombin and von Willebrand factor.

Indication
● Patients on anticoagulant drug therapy
● Antithrombin deficiency
● Coagulopathy of liver diseases
● Vitamin K deficiency
● Disseminated intravascular coagulation
● Massive BT
● Immunodeficiencies
Cryoprecipitate

● Cryoprecipitate contains significant levels of factor VIII, fibrinogen, von Willebrand factor and fibronectin.
● It is extracted from slowly thawing FFP.

Indication
● Patients who need fibrinogen, factor VIII and vWF.
● Transfusion of single unit of cryoprecipitate provides about 80 IU of factor VIII.
Prothrombin complex

● Factor IX can be recovered from plasma or plasma fractions by absorption with ion exchanges or
inorganic chemicals.
● Main indication for this product is treatment of factor IX deficiency or hemophilia B.

Single Donor Plasma

● Single donor plasma is very effective as volume expander.
● It is removed from stored blood without any effort beingmade to preserve coagulation factors.
 COMPLICATIONS OF
BLOOD TRANSFUSION
Govindam Sharma
19042
A carefully prepared and supervised blood transfusion is quite safe .
However, in 5-6% of transfusions, untoward complications occur, some
of which are minor while others are more serious and at times fatal.
Transfusion reactions are generally classified into 3 types :
1. IMMUNE COMPLICATIONS
2. INFECTIOUS COMPLICATONS
3. OTHERS
HAEMOLYTIC REACTIONS
1.MAJOR (ABO) INCOMPATIBILITY REACTION
• This is a result of mismatched blood transfusion.
• The majority of the cases are due to technical errors, such as sampling , labelling and dispatching.
• This causes intravascular haemolysis.
C/F – Haematuria
• Pain in loins (B/L)
• Fever and chills with rigor
• Oliguria due to products of mismatched blood transfusion blocking the renal tubules . It results in
acute renal tubular necrosis.
TREATMENT – stop the transfusion send blood back to blood bank and recheck.
• Repeat coagulation profile.
• IV fluids , monitor urine output , check Hb.
• Diuresis with furosemide 20-40mg Iv or inj. Mannitol 20% 100 Ml IV to flush the kidney.
• If renal failure does occur , haemodialysis may be required.
• If haemodynamically unstable , cardiovascular support may be required .
2. MINOR INCOMPATIBILITY REACTION
• Results in extravascular haemolysis
• Usually mild , occurs at 2-21 days
• Occurs due to antibodies to minor antigens
• Malaise, jaundice and fever are seen
• Supportive treatment is given
NON HAEMOLYTIC REACTONS
1. FEBRILE REACTION
• Occurs due to sensitisation to WBCs and platelets
• Increased temperature – no haemolysis occur.
• Use of leucocyte depleted blood may prevent it.
2. ALLERGIC REACTION
• Occurs due to hypersensitivity reaction to plasma products .
• Manifests as chills , rigors , and rashes.
• Often subsides with antihistamines such as chlorpheniramine maleate 10 mg IV.
TRANSFUSION RELATED ACUTE LUNG INJURY (TRALI)
It is a rare complication , that occurs within 6 hours of a transfusion due
to the presence of antileucocyte antibodies in the transfused plasma
which cause the patient’s white blood cells to aggregate in the
pulmonary circulation .
This leads to degranulation of leucocytes , causing increased capillary
permeability and non cardiogenic pulmonary oedema . Symptoms may
vary from mild dyspnoea to full blown acute respiratory distress
syndrome. Proper supportive therapy will help resolve it in 24-48 hours.
CONGESTIVE CARDIAC FAILURE (CCF)
• CCF may occur if whole blood is transfused rapidly especially in patients with chronic
anaemia due to circulatory overload.
TREATMENT-
• Slow transfusion , injection furosemide 20 mg IV.
• Packed cell transfusion is the choice in these patients.
INFECTIOUS COMPLICATIONS
• Serum hepatitis, AIDS , malaria and syphilis are the most common infectious diseases that
may be transmitted from one patient to the other patient through blood transfusion.
• The danger is increased in cases of multiple tranfusions and in emergency situations.
Hence it is mandatory to screen the blood for these diseases before transfusion.
Other complications-
Citrate toxicity ( causing hypocalcemia)
Dilutional coagulopathy ( thrombocytopenia and dilution of clotting
factors) can occur in massive transfusion.
Temperature : administration of unwarmed blood that has been stored
at 4°C can decrease the recipients temperature . If the temperature
decreases to 30°C then ventricular instability and cardiac arrest can
occur.
DISSEMINATED INTRAVASCULAR COAGULATION (DIC)
• It occurs in massive blood transfusion , wherein all factors of
coagulation are consumed , resulting in a bleeding disorder
(consumption coagulopathy).
• It produces severe afibrinogenemia.
• It is treated by replacement with fibrinogen (cryoprecipitate) and
other clotting factors.
MASSIVE BLOOD TRANSFUSION
It is defined as
-replacement of >1 blood volume (or > 10 units of packed cells) in 24
hours.
- Half the patients blood volume in 6 hours .
- >4 RBC units in one hour with ongoing need for transfusion or,
- 500 ml over 5 mins with haemodynamic instability and need for transfusion.
Massive blood loss can occur with trauma , post partum haemorrhage or
during other major surgeries.
SUMMARY
• Blood transfusion is an essential component of obtstetric care and at times life saving. Inappropriate
transfusions during pregnancy and the post partum period expose the mother to the risk of HDFN.
• In the situation of obstetric haemorrhage early resuscitation is done with crystalloids/or colloids
with oxygenation while simultaneously taking all steps to control bleeding and reduce the
transfusion requirement.
• The decision to perform blood transfusion should be made both on clinical and haematological
grounds.
• The majority of ptotocols suggest that to maintain hematocrit at 21-24% while in actively bleeding
patients Hct should be 30%.
• To avoid dilutional coagulopathy , concurrent replacement with coagulation factors and platelets
may be necessary.
• Whole blood may be preferred in acute massive haemorrhage especially where blood components
are not readily available.
Thank you